Help, My Son Has an Eating Disorder

Eating disorders are most commonly seen in girls and women. However, the number of men who are struggling with an eating disorder is increasing [1]. Some statistics about boys and men with eating disorders are:

  • Mortality rate for men due to disordered eating may be higher for men than it is for women
  • The majority of boys and men with eating disorders are heterosexual
  • About 3% of boys are estimated to experience an eating disorder by age 20
  • Males tend to develop eating disorders at younger ages compared to girls [1,2]

These types of mental conditions can wreak havoc on someone’s physical and emotional health. Identifying disordered eating is the first step in treating it.

The Different Types of Eating Disorders

While some of the signs and symptoms of eating disorders can overlap regardless of diagnosis, there are different types of eating disorders. Anorexia and bulimia are the most commonly talked about eating disorders, but there are other conditions that are just as serious and warrant treatment. The different eating disorder diagnoses are:

Anorexia Nervosa

Anorexia is an eating disorder characterized by severe food restriction. This food restriction results in being underweight and malnourished. Someone with anorexia severely limits their food intake out of a fear of becoming fat or gaining weight.

This fear can cause significant emotional distress. People with anorexia may also compulsively exercise, purge, or use laxatives.

Bulimia Nervosa

People with bulimia engage in cycles of binging and purging. A binge is when someone eats an amount of food that is so large, most people wouldn’t eat the same amount of food in the same amount of time.

These binges are followed with a behavior intended to offset the “consequences” of binging. Compensatory behaviors could be self-induced vomiting, laxative use, fasting, or compulsive exercise.

Binge Eating Disorder (BED)

BED is an eating disorder characterized by frequent binges. As mentioned above, a binge is when someone eats an amount of food that is larger than what most people would eat in the same amount of time. These binges are followed by feelings of guilt, disgust, and other distressing feelings.

Pica

Someone is diagnosed with pica when they eat things that are not considered food, such as dirt, lead pencils, ash, or bricks. There is a wide range of items that may be consumed. This behavior is compulsive.

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is similar to Anorexia in that people with ARFID also significantly restrict their food intake. However, this food restriction isn’t driven by a fear of gaining weight or concern about their body image.

Rumination Disorder

Rumination disorder is when someone regurgitates their food. Someone with this disorder may re-swallow, re-chew, or spit out their food. This behavior isn’t intentional and isn’t due to emotional discomfort with eating.

Unspecific Feeding or Eating Disorder

This diagnosis is given when someone is displaying disordered eating symptoms, but they don’t fully meet the criteria for another eating disorder. This diagnosis is just as serious as other eating disorder diagnoses given the potential impact of eating disorder behaviors.

Other Body Concerns

While not considered an eating disorder, there are other disorders that can result from body image concerns, such as compulsive exercise or body dysmorphic disorder.

Body dysmorphic disorder is a condition in which someone essentially obsesses about a perceived physical flaw. Even if this flaw is minor, for the person with this disorder the flaw can be a source of extreme anxiety and shame. One example of this is muscle dysmorphia [3].

Muscle dysmorphia is when someone feels an immense pressure to be muscular. This is sometimes referred to as “reverse anorexia” as there is a pressure to be bigger, rather than smaller [3].

Boys and men are flooded with messages from the media that the most attractive male body is big and strong. This can lead to an obsessive attempt to be as big as possible. People with muscle dysmorphia may not have an accurate perception of the size of their body. Similar to how someone with anorexia may look in the mirror and see a much bigger body than they actually have, someone with muscle dysmorphia may see a much smaller body than what they have.

Gender Differences in Diagnosis and Treatment

Research shows that boys tend to have more severe medical complications from eating disorders, yet do not get diagnosed as often as girls do [2].

This may be due to gender expectations and bias. It is difficult to determine exactly why this is the case. Part of this may be that the screening tools assess for symptoms that common in girls [2].

However, it’s also possible that providers don’t assess for or diagnose boys and men with eating disorders due to the stereotype that only girls and women experience these conditions.

Another factor may be that many boys and men have been socialized to not talk about their struggles or emotions, that they don’t reach out for help. This can make it easier to miss the signs and symptoms of disordered eating if your son is acting as if everything is fine.

Related Reading

Signs of Eating Disorders in Boys

Signs of an eating disorder include:

  • Any behavior that suggests that weight loss or dieting is becoming a main concern
  • Obsession or preoccupation with weight, food, or calories
  • Skipping meals or only eating small amounts
  • Isolating from friends and family
  • Significant concern with body image
  • Frequently checking in the mirror or doing other things to check the size or shape of their body
  • Mood swings
  • Changes in weight, whether losing or gaining weight
  • Dizziness
  • Abnormal lab results
  • Difficulty falling or staying asleep
  • Concentration difficulties
  • Dental problems
  • Frequently going to the bathroom right after or during a meal
  • Exercising even if it interferes with other important activities or responsibilities
  • Intense anxiety, depression, or guilt with eating or if unable to exercise
  • Exercising even if injured or sick [4]

What Causes Eating Disorders in Boys

There isn’t just one thing that can cause an eating disorder. Eating disorders are complex diagnoses. However, there are certain environmental, emotional, and biological factors that can increase the risk of developing an eating disorder. These include:

  • Negative body image
  • History of physical or sexual abuse
  • Participating in weight-class (i.e wrestling) or aesthetic (i.e ballet, figure skating) sports
  • Family history of eating disorders
  • Untreated mental illnesses, such as depression or anxiety
  • Low self-esteem
  • Personality traits like perfectionism of rigid thinking [5]

What to Do if Your Child Has an Eating Disorder

If your child has an eating disorder, it’s important to get help. It can be difficult to bring this up to your son. Here are some tips for talking about this with him:

  • Stay calm and curious: Conversations about mental health are important, but tend to feel vulnerable. It is easy for people to shut down or become defensive in these types of conversation. If you are able to stay calm and open to what your child shares with you, there is a greater chance that they’ll be open and honest with you.
  • Comment on what you’ve observed: It’s very common for people with eating disorders to be in denial in the beginning. If you come to your son assuming he already knows he has an issue, that might create roadblocks in the conversation. It can be helpful to instead comment on what you’ve observed. Such as, “I notice that not being able to exercise really is getting under your skin lately” or “You haven’t been eating as much as you normally do. Is something going on?”
  • Offer support: Even if your child isn’t open to support at first, offering it is a way to plant a seed. Offering support can sound like, “It seems like something is going on. Is there anyway I can help?” Another example is, “I can tell you seem down. Would it help if I listened or is there something you would find helpful?”

Seeking Eating Disorder Treatment for Your Son

Treatment for an eating disorder can be lifesaving. There are a few different ways to go about getting eating disorder treatment for your son. These options include:

  • Search for treatment providers in your area. You can do a google search or use a tool like this to find local providers.
  • Ask your insurance provider for referrals. Insurance companies typically have a list of providers that are in-network for your plan.

There’s a wide range of treatment options available. It can be intimidating to start this process, but treatment is necessary for healing and recovery.

 

Citations

[1] National Eating Disorders Association. (n.d). Statistics and Research on Eating Disorders. Retrieved January 15th, 2022 from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

[2] Coelho, J.S., Lee, T., Karnabi, P., Burns, A., Marshall, S., Geller, J., & Lam, P. (2018). Eating disorders in biological males: Clinical presentation and consideration of sex differences in a pediatric sample. Journal of Eating Disorders, 6(40), 1-12.

[3] Leone, J.E., Sedory, E.J., & Gray, K.A. (2005). Recognition and treatment of muscle dysmorphia and related body image. Journal of Athletic Training, 40(4), 352-359.

[4] National Eating Disorders Association. (n.d). Warning Signs and Symptoms. Retrieved January 15th, 2022 from https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

[5] American Academy of Pediatrics. (2015, November 11). Is Your Teen at Risk for Developing an Eating Disorder? Retrieved October 13th, 2021 from https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Is-Your-Teen-at-Risk-for-Developing-an-Eating-Disorder.aspx

Author: Samantha Bothwell, LMFT
Page Last Reviewed and Updated by Jacquelyn Ekern, MS, LPC  3.1.2022